Factors influencing the fascial closure rate after open abdomen treatment: Results from the European Hernia Society (EuraHS) Registry

Abstract

Purpose Definitive fascial closure is an essential treatment objective after open abdomen treatment and mitigates morbidity and mortality. There is a paucity of evidence on factors that promote or prevent definitive fascial closure. Methods A multi-center multivariable analysis of data from the Open Abdomen Route of the European Hernia Society included all cases between 1 May 2015 and 31 December 2019. Different treatment elements, i.e. the use of a visceral protective layer, negative-pressure wound therapy and dynamic closure techniques, as well as patient characteristics were included in the multivariable analysis. The study was registered in the International Clinical Trials Registry Platform via the German Registry for Clinical Trials (DRK00021719). Results Data were included from 630 patients from eleven surgical departments in six European countries. Indications for OAT were peritonitis (46%), abdominal compartment syndrome (20.5%), burst abdomen (11.3%), abdominal trauma (9%), and other conditions (13.2%). The overall definitive fascial closure rate was 57.5% in the intention-to-treat analysis and 71% in the per-protocol analysis. The multivariable analysis showed a positive correlation of negative-pressure wound therapy (odds ratio: 2.496, p < 0.001) and dynamic closure techniques (odds ratio: 2.687, p < 0.001) with fascial closure and a negative correlation of intra-abdominal contamination (odds ratio: 0.630, p = 0.029) and the number of surgical procedures before OAT (odds ratio: 0.740, p = 0.005) with DFC. Conclusion The clinical course and prognosis of open abdomen treatment can significantly be improved by the use of treatment elements such as negative-pressure wound therapy and dynamic closure techniques, which are associated with definitive fascial closure.

The temporary abdominal closure techniques used for trauma patients: a systematic review and meta-analysis

“…If DFC cannot be achieved within 8 days, the current trend advocates the initiation of DT [ 7 60 ]. Numerous reports have demonstrated that NPWT with CFT yields better results than NPWT alone, although most study participants evaluated in these prior studies were non-trauma patients [ 2 61 62 ]. Accordingly, the World Society of Emergency Surgery and the Eastern Association for the Surgery of Trauma (EAST) recommended NPWT with CFT as the primary technique for TAC [ 8 63 ].…”

Use of a visceral protective layer prevents fistula development in open abdomen therapy: results from the European Hernia Society Open Abdomen Registry

“…The effect of negative-pressure wound therapy in open abdomen treatment and the risk of fistula development is debated; however, a shorter duration of open abdomen therapy combined with dynamic closure techniques has been shown to be both safe and effective 3 , 11 , 12 .…”

“…In that study, a remarkable 10-fold risk reduction in enteroatmospheric fistula development was shown when a VPL was used. Moreover, another recent analysis from the EHS Open Abdomen Registry 12 found the combination of negative-pressure wound therapy, VPL, and dynamic closure techniques to be beneficial in terms of achieving fascial closure and thus reducing complications. This was also addressed in the 2018 EHS clinical guidelines 4 on the management of the abdominal wall in the context of open and burst abdomen.…”

“…A pooled incidence of enteroatmospheric fistula of 4.3 per cent was reported for dynamic closure techniques versus 11.9 per cent for static closure techniques, and the use of dynamic closure techniques in uncomplicated open abdomen therapy (Björck grades I and II) was therefore recommended 4 . When dynamic closure techniques are used, in particular mesh-mediated traction, it is imperative to consider that direct contact between the mesh material and oedematous or granulating intestinal serosa without a VPL should be avoided because of the significant risk of complications 5 , 12 .…”

Study protocol for a multicenter randomized controlled pilot study on decompressive laparotomy vs. decompressive craniectomy for intractable intracranial pressure after traumatic brain injury: The SCALPEL study

“…But using vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) as a measure to dynamically approximate and close the rectus abdominis fascia with staged surgical procedures and a visceral protective layer to the vacuum dressing to avoid entero-atmospheric fistulas, morbidity of that procedure will be much lower than 20 years ago ( Beltzer et al, 2016 ; Coccolini et al, 2018 ; Schaaf et al, 2020 ; Weigelt and Kingman, 1988 ; Willms et al, 2015 , 2020 , 2022 ).…”